NUR 634 Advanced Health Assessment
Midterm exam with answers
Subjective History Components - answer chief complaint, HPI, PMH, family history,
social
... [Show More] history, & review of systems: what patient tells you.
Objective History Components - answer General survey, vitals, physical exam,
diagnostic results, what you observe or see.
Presbyopia - answer age-related near-vision loss. Can see far away better.
Examples of sudden, painful unilateral vision loss - answer corneal ulcer, acute closed
angle glaucoma, uveitis, or traumatic hyphema.
Examples of sudden, PAINLESS unilateral vision loss - answer retinal detachment,
macular degeneration, or retinal vein occlusion.
Olfactory (CN 1) - answer smell, occlude each nostril
Optic (CN 2) - answer Vision-Snellen chart, an enlarged blind spot affects optic nerve
caused by glaucoma, optic neuritis, and papilledema.
Oculomotor Nerve (CN III) - answer Test PERRLA, Paralysis if the pupil is dilated, fixed
to light and near accommodation with ptosis, lateral deviation of the eye. Impaired ability
to look up, down, or inward. (A conjugate gauze is a normal gaze=both eyes move in
same direction at same time). ptosis=CNIII problem.
Trochlear Nerve (CN IV) - answer controls superior oblique muscle-moves eye down
towards nose, damage from head trauma or central lesions=diplopia. Diplopia is also
seen in cataracts, astigmatism, or CN III, IV, or VI neuropathy, or myasthenia gravis,
trauma, or lesions in brainstem or cerebellum.
Trigeminal (CN V): - answer Facial sensation, nasal and buccal mucosa, & teeth,
mastication muscles. Test corneal reflex, have pt clench teeth/palpate
masseter/temporal muscles, sharp/dull sensations on cheek/forehead.
Abducens (CNVI) - answer Movement of lateral rectus muscle, moves eye laterally.
Facial (CN VII) - answer Facial muscles, taste anterior 2/3rd of tongue. Have pt smile,
show teeth, raise eyebrows, frown, close eyes tight, puff out cheeks. Bell's Palsy.
Vestibulocochlear (CN VIII) - answer Sensation to pharynx, posterior 1/3rd of tongue,
and tympanic membrane. Test gag reflex.
Vagus Nerve (CN X) - answer Supplies parasympathetic nerve fibers to viscera of
chest, abdomen, motor fibers to pharynx, larynx. *A deviated uvula without swelling
indicates vagus nerve lesion.
Spinal Accessory (CN XI): - answer Supplies motor fibers to sternocleidomastoid &
trapezius muscle, ask pt to shrug shoulders against your hands.
Hypoglossal (CN XII): - answer Tongue muscles, ask pt to move tongue all around.
Glaucoma - answer gradual loss of peripheral vision, optic nerve damage. Open
Angle=asymptomatic, bilateral, gradual increased cup-to-disk ratio from increased
intraocular pressure=notching of optic cup. Acute Closed Angle rapid onset of sudden
vision loss, unilateral, deep eye pain, dilated and fixed pupil with cloudy
cornea=emergency if increased intraocular pressure.
Macular Degeneration - answer gradual loss of central vision d/t damaged retina.
Cataracts: - answer gradual cloudiness/opacification of the lens from DM,
overexposure to sun, long-term steroid use, diuretics, poor diet, smoking, ETOH, age,
trauma, lead exposures=NO red reflex, Leukoria-white reflex present, blurred/cloudy
vision, halo around lights, diminished night vision, diplopia, fall risk.
Normal Retina: - answer present red reflex, veins pulsate, arteries narrower. Normal
Cup/Disk ratio is 1/3, fovea is in middle of macula.
AV Tapering - answer vein "winds" or tapers down on either side of artery.
AV Nicking - answer vein stops abruptly on either side of artery, arteries indent and
displace veins, caused by HTN
AV Banking - answer vein is twisted on distal side of artery
Subconjuncival Hemorrhage: - answer red painless eye.
Red & Painful eye - answer Hyphema (blood in anterior chamber of eye), episcleritis
(inflammation of episcleral vessels in RA or herpes), acute angle closer glaucoma, or
uveitis.
Amblyopia - answer Reduction in vision causing loss of binocular vision from cataracts
or untreated strabismus (cross-eyed detected with cover-uncover test or Hirschberg
Test- will show asymmetric light reflex, pt c/o diplopia).
Esotropia: - answer eye drifts in
Exotropia - answer eye drifts out [Show Less]
